This project will address the Broad Challenge Area of Health Disparities and the specific Challenge Topic 09-DE-101, Behavioral and Social Science to Reduce Oral Health Disparities. Although small-scale studies have evaluated oral disease in the developmentally disabled, the oral health status, treatment needs and helpful interventions for adults with developmental disabilities (DD) are largely unknown. The inability of many adults with DD to perform preventive home care - because of cognitive, physical, and/or sensory limitations - coupled with a lack of understanding about the value of daily oral care and regular dental visits among some caregivers, also creates significant barriers. Little is known about the characteristics of adults with DD, their caregivers, and their living environments that facilitate or impede preventive home care and regular dental visits. This information is essential to create best practices for dental treatment guidelines for persons with DD and to develop compensatory strategies and environmental modifications to promote their oral health. We propose to address this gap by using data from an exceptional dental care system for the disabled in Massachusetts administered by Tufts University School of Dental Medicine (TUSDM). Tufts Dental Facilities are an 8-clinic system that serves approximately 7000 adults with DD. An interdisciplinary team with expertise in dentistry, epidemiology, health and disability policy, nutrition, and biostatistics will be assembled to meet the following specific aims: Aim 1: Describe the oral health status of people with DD, based on comprehensive dental examinations. Aim 2: Identify individual and caregiver factors associated with poor oral health. Aim 3: Develop an oral health promotion protocol based on the results from Specific Aims 1-2. Relevant clinical data for a 12-month period will be exported from the customized electronic health record system. Surveys will be self-administered to caregivers across the range of living environments in which these patients live to understand the environmental factors that influence the oral health status of adults with DD. Confirmatory focus groups will be conducted with caregivers across living situations to deepen our understanding of the barriers and facilitators, and will provide the opportunity to refine the health promotion intervention we will design. Our efforts will provide a foundation of knowledge that will be made available to dental professionals, state agency administrators, policy makers, residential providers, families and advocates to develop effective strategies to preserve and protect the oral health of this group. Oral Health Status and its Correlates in Adults with Developmental Disabilities Project Narrative: The oral health status and treatment needs of adults with developmental disabilities (DD) are largely unknown as are the characteristics of caregivers (the family members and paid staff who help with activities of daily living) and living environments that facilitate or impede preventive home care and regular dental visits. Analysis of data from the electronic dental record of 7,000 DD patients undergoing treatment at state- supported dental clinics in Massachusetts, surveys of caregivers, and confirmatory focus groups will be used to describe dental disease in this population and develop an oral health promotion protocol to address the factors identified in this research project.